Healthcare Provider Details

I. General information

NPI: 1124831318
Provider Name (Legal Business Name): RENOVATING HOPE COUNSELING AND SPIRITUAL DIRECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SUN VALLEY DR STE L3
ROSWELL GA
30076-5630
US

IV. Provider business mailing address

555 SUN VALLEY DR STE L3
ROSWELL GA
30076-5630
US

V. Phone/Fax

Practice location:
  • Phone: 404-369-8957
  • Fax:
Mailing address:
  • Phone: 404-369-8957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN E SHOEMAKER
Title or Position: LPC
Credential: MAED
Phone: 843-412-0776